Release of Information

This form will allow Clarksville Behavioral Health (CBH) to send and receive medical information as needed. You will need to print the form out, complete it, and send it to the following address:

Dr. James Dodson

1145 Teacher Drive

Clarksville, TN 37043

Form: Release of Information Form * Please add address and fax number as needed *

*Note: It can take more than two weeks for your records to be compiled and mailed out. We will try to be quick, but life happens.*